3 guarantees travel nurses would need from their hospitals to return

Some travel nurses who left full-time hospital jobs during the pandemic have no plans to return. But there is a subset of reachable nurses who say they would consider returning to a full-time bedside role if hospitals made certain guarantees. 

Hospitals heavily relied on travel nurses when the novel coronavirus began spreading in the U.S. Unprecedented demand sent rates soaring, enticing many staff nurses who may have never thought about travel work to take the leap. From January to March 2020, the number of travel nurses doubled from 50,000 to at least 100,000, according to data from Staffing Industry Analysts cited by NBC News. Travel nurse demand is now falling, with data from staffing firm Aya Healthcare showing demand dropped 42 percent from January to July of this year. And with a drop in demand comes falling pay, though travel rates still remain higher than pre-pandemic levels. 

Becker's heard from several travel nurses who say nothing could make them return to their staff nurse positions, saying the higher pay and scheduling flexibility offered by contract assignments outweigh any changes hospitals could make to lure them back. 

Others told Becker's they would return to staff nursing, but only if hospitals made several significant commitments to improve compensation, staffing and patient safety. 

Better pay as a staff nurse 

Higher pay for full-time nurses would, of course, sway those who left for travel work to come back. But significant gaps between staff nurse pay and temporary contracts remain. Travel nurses in 2021 were earning an average of about $125 an hour, Staffing Industry Analysts told NBC. That's almost three times the hourly rate of a staff nurse, according to data from the Bureau of Labor and Statistics. 

Pamela Esmond, RN, 59, of northern Illinois became a travel nurse during the pandemic. She told NBC News Sept. 3 she plans on working as a travel nurse until she retires at 65 in order to afford retirement. 

"The reality is they don’t pay staff nurses enough, and if they would pay staff nurses enough, we wouldn’t have this problem," Ms. Esmond said. "...I would love to go back to staff nursing, but on my staff job, I would never be able to retire." 

Shauna Painter, RN, ADN, worked at Walmart to pay for nursing school. At a certain point, she said, she realized that she would make more money as a store manager than a "highly trained ICU nurse." 

"Ultimately, I followed my passion for patient care and chose nursing, but it’s simply too hard to make a living as a nurse on regular pay," Ms. Painter told Becker's

Ms. Painter spent more than six years as a staff nurse and made the switch to travel nursing about two and a half years ago when the pandemic began. During her time in the traditional healthcare setting, she said she was living "paycheck to paycheck."

"In 2020, my take home pay as a staff nurse was roughly $1,500 every two weeks, which was the same amount as my mortgage," Ms. Painter said. "Most nurses are working overtime so they can simply pay their bills. Nurses with student loans have it even harder." 

For travel nurses, it's simple: "Hospital systems need to do a better job at valuing a nurse’s (and all hospital staff's) worth and paying them accordingly," Ms. Painter said. "Compensation should match expertise, training and worth."

For hospitals, however, the ask is more complex. Health systems have said they couldn't consistently afford to pay full-time staff nurses wages meant for temporary assignments. In January, Pittsburgh-based UPMC's chief human resource officer John Galley told Becker's that salaries and benefits make up about half of a health system's entire operating expenses. 

"If you were to double a good portion of that — the nursing salaries — you'd completely wipe out any operating margin. Then you wouldn't be able to invest in anything to keep the hospitals going," he said. 

Flexible scheduling 

In addition to better pay, travel nurses say hospitals would need to promise greater schedule flexibility to get them back.  

"With travel nursing, I have found that compensation is much higher, and I have more control over my schedule," Yasmine Seidu, BSN, RN, told Becker's. "I can get time off when needed after each contract and vacation with my family as long as I want to."

Ms. Seidu had a pregnancy complication and said she only had six weeks with her newborn before returning to her staff nursing role. "If my baby was born when I was working as a travel nurse, I could take all the time I needed to bond with my child with no restrictions and fear of losing my job if I stayed longer," she said.

Jennifer Zahourek, RN, began travel nursing a year into her career. She enjoyed the flexibility the work had to offer and was able to start her own business after three years. "Now I randomly go back into travel assignments," she told Becker's. "I only look for assignments where [the administration] is willing to work with my schedule and has great teamwork."

Guaranteed nurse-patient ratios  

The travel nurses that spoke with Becker's also noted safety as a concern, namely the lack of nurse-to-patient ratios in traditional healthcare settings. Amid chronic workforce shortages, caring for too many patients at once is commonplace and can pose risks to patient safety, they say. 

"Most staff nurses are taking 5 or 6 patients in med-surg units, which is understandable given the nursing shortage, but it means that staff nurses are often working long hours without any breaks," Ms. Painter said. "It also means that in some cases, patients are not receiving the adequate time with their nurses that they deserve." 

California is currently the only state to have successfully legislated nurse-to-patient ratios, requiring hospital wards to maintain a ratio of 1 nurse for every 5 patients, while intensive care units must maintain a 1:2 ratio.

"Travel nurses are often assigned fewer patients," Ms. Painter said. "So as a traveler, I am able to focus more on the patient than the traditional staff nurse who is overextended."

The length of travel nursing contracts — typically 13 weeks — allows for more flexibility in deciding what environments are best, Ms. Seidu said. 

"If I walk into a contract that I feel is unsafe, I know at least I only have to endure it for a short period," she said. "Whereas, in a traditional setting, I would be stuck in an unsafe work environment with high work ratios for an indeterminate amount of time unless I decide I want to leave and start over at a new facility, which can often be just as short-staffed."

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